Inpatient versus outpatient

[David1961]

I recently had a surgery planned at a hospital as an outpatient service, but because the surgery was a little more involved, I was admitted and stayed overnight. My insurance requires pre-certification for hospital admission but since I did not know I'd be admitted, the pre-certification could not have been done ahead of time. Is something like this considered outpatient or inpatient when it is submitted to the insurance company? I have done some research and the criteria seems to be if you were in the hospital at least 24 hours, it is considered inpatient. I was actually there about 28 hours so seems like it should be inpatient. This same experience happened about 4 years ago and it was treated as an inpatient. Have the rules changed or became fuzzy the past 4 years?

 

[Dash man]

It should be considered an emergency admittance which shouldn't require pre-certification. Not everything can be planned.

 

[pb4uski]

It should be considered an emergency admittance which shouldn't require pre-certification. Not everything can be planned.

Sounds right to me. Your doc/providers should be able to work it out with your insurer.

 

[Texas Proud]

It should be considered an emergency admittance which shouldn't require pre-certification. Not everything can be planned.

How can something that was planned be considered an emergency

 

[Dash man]

How can something that was planned be considered an emergency

The overnight admission wasn't planned. Something happened during the procedure to change the mind of the doctor about sending him home, preferring to have him monitored in the hospital overnight.

 

[foxfirev5]

How can something that was planned be considered an emergency

Complications. Evidently you have not had much experience with medical problems, like me. However shocking it may be, sometimes things don't go as planned.

 

[Texas Proud]

The overnight admission wasn't planned. Something happened during the procedure to change the mind of the doctor about sending him home, preferring to have him monitored in the hospital overnight.

Complications. Evidently you have not had much experience with medical problems, like me. However shocking it may be, sometimes things don't go as planned.

OK.... misread the post... thought they admitted him before the surgery.... my bad..

 

[MRG]

Sounds right to me. Your doc/providers should be able to work it out with your insurer.

I would notify the insurance company myself. Agree the DRs and other providers will provide the documentation.

I only add this as one horrible policly I had many years ago had a provision that the patient had to inform them. I never did get them to answer the obvious question; what if I'm incapable of calling you?
MRG